Global Oral Health InequalityOral diseases affect around half of the global population. Global oral health profiles show that the majority of those burdened by oral diseases are living in poverty, and this indicates an oral health inequality issue. Even more, standard oral health services are not readily available in many low-income and middle-income countries.

The Burden of Oral Diseases

In November 2022, the World Health Organization (WHO) published the Global Oral Health Status Report which revealed the organization’s aim for universal health coverage for oral health by 2030. Following this report, in January 2023, was WHO’s Global Oral Health Action Plan.

These reports highlighted that oral diseases present a burden greater than the next five most prevalent non-communicable diseases combined. This burden primarily comes from untreated tooth decay, gum disease and cancers of the lip and oral cavities, all of which are largely preventable. According to the same reports, oral diseases such as gum disease may develop into other conditions such as diabetes and cardiovascular problems.

Despite the fact that the global burden of oral diseases costs around $387 billion, only 4.6% of global health care expenditure goes toward dental and oral care. For this reason, the WHO emphasized the need for immediate interventions that focus on oral health.

Oral Health Inequality

The WHO’s reports outlined the first global oral health profile which highlighted that developing nations, particularly in the South-East Asian and Western Pacific regions, face the highest levels of oral health challenges. As reported by the organization, “oral diseases disproportionately affect the poor and socially disadvantaged.” Consequently, vulnerable groups face issues ranging from reduced productivity to school disruption, all of which can lead to poverty.

Multiple social, cultural, economic and behavioral factors contribute to the existing disparities in oral health. Developing countries undergoing social and cultural transformations are experiencing a surge in oral diseases due to lifestyle choices. Nevertheless, access to oral health care remains limited in these countries, and where available, it is often unaffordable and unsuitable for the majority of the population grappling with oral ailments. This highlights two key determinants of oral health inequality which are health care accessibility and lifestyle choices.

Oral Health Care Accessibility

The first significant determinant of oral health is the cost of available dental care and the disposable income of the population. At both national and global scales, there is a clear economically-based distribution of oral health care provision. Of the total number of dentists worldwide, only 1.4% work in low-income countries

According to the WHO’s report, the best way to ensure excellent oral health is to prioritize preventative measures. However, this relies on a health care system having the funds to sustain regular dental care and universal basic dental care coverage. As things stand, only the richest societies can afford a regular and sufficient supply of dental professionals and services. 

National governments and the international community could effectively combat economically-based oral health inequality and access to oral health care by funding more accessible and affordable health care for those in developing nations. A cost-effective approach promoted by the WHO involves the use of innovative digital health tools, such as telehealth and video-supported health. Teledentistry typically involves an online dental consultation that makes dental support more accessible to those who cannot get face-to-face care. For example, Unilever provides a teledentistry service in South-East Asia, with the aim of reaching over 200 million people. 

Lifestyle Choices

Another determinant of oral health inequality is the social and personal beliefs and habits people have around oral health. The consumption of sugar, alcohol and tobacco contributes to a range of non-communicable diseases that affect oral health. Additionally, a lack of education about oral hygiene can prevent people from taking the necessary personal care measures.

As a way to solve this problem, policymakers could focus on increasing health literacy and encouraging good oral hygiene among affected populations. Commercial advertising from large companies has been partly responsible for promoting habits like smoking and alcohol consumption, which can negatively impact oral health. The WHO suggests that these same companies hold the potential to promote beneficial habits such as those that support oral health among children and adults.

Digital Media and Oral Health

Low-income nations may not have the financial resources to implement effective media campaigns that focus on behavior change. However, the advent of digital media offers a potentially more accessible alternative. Online advertising campaigns are not only less costly, but they can also reach a wider audience.

During the COVID-19 pandemic, Unilever collaborated with Cartoon Network to introduce an online educational program named Little Brush Big Brush. The program featured a series of videos that taught children about the significance of oral hygiene, with a particular emphasis on tooth brushing. Brushing teeth twice a day with fluoride toothpaste can decrease the risk of tooth decay by 90%. Programs like this have the potential to create significant change since they can reach a vast audience. For instance, 95% of the global internet population watches videos on YouTube alone.

Looking to the Future

Current global patterns show that those living in poverty are most at risk from preventable oral diseases. While face-to-face dental care may be unaffordable for many, the growth in access to the Internet provides a more cost-effective solution. Through the expansion of digital health care and online advertising to promote positive behavior changes, there is hope to reach a much wider audience and reduce oral health inequality for the present and the future.

– Polly Walton
Photo: Flickr

Oral hygienePeople are often taught to brush and floss their teeth twice a day to prevent cavities or other oral diseases. Some estimates suggest that roughly 60-90% of children around the world and 100% of adults have cavities or another type of dental carie. These seemingly high rates of poor oral hygiene are present almost everywhere. The lack of market infrastructure and limited transportation can make acquiring seemingly simple items such as toothbrushes and toothpaste difficult or impossible in many countries. However, Sweet Bites, the first chewing gum made entirely of xylitol, was created for the sole purpose of providing an easy and affordable way for children and adults to protect their smiles from the debilitating problems associated with tooth decay.

Effects of Poor Oral Hygiene

The term “oral hygiene” can often be misleading. Oral hygiene is not limited to mouth diseases but can negatively affect people’s overall well-being. Potential short-term effects include a buildup of dental plaque, bad breath, breakouts and skin infections. Meanwhile, potential long-term effects include a risk of serious oral inflammation and a depressed immune system as well as tooth decay, cavities, gum disease and tooth loss.

The Science Behind Xylitol

Xylitol is a sugar alcohol that can be harvested from plants and is known to reduce plaque. This would also subsequently decrease the probability of tooth decay. Sweet Bites claims that “chewing xylitol-sweetened gum for five minutes after every meal can protect a person’s mouth from tooth decay, caries and all of the consequences that follow, including increased risk for cardiovascular disease.”

Five students from the University of Pennsylvania are the visionaries behind Sweet Bites. Although the health benefits of xylitol are not a new discovery, the young entrepreneurs’ three-pronged plan to help those suffering from tooth decay is admirable.

Sweet Bites Changes Lives

Sweet Bites’ mission is to “Fight Tooth Decay. Educate Children. Empower Students.” The entrepreneurs’ plan to address oral hygiene by selling their pure xylitol gum in stores throughout India’s most impoverished areas. The organization also has representatives traveling to schools, businesses and community events to educate the people of India on the importance of oral hygiene. This includes “health messaging on the wrapper, so each piece reinforces important behaviors, like brushing twice a day.” Lastly, Sweet Bites provides part-time work to local students. This ensures the chewing gum remains distributed by members of the community who understand the magnitude of the issue.

Currently, Sweet Bites is running various funding campaigns and applying for grants to bring their life-saving gum to the people of India at an affordable price. The Sweet Bites health initiative remains limited to India. However, the company’s CEOs are working to secure factory space so that their product can reach people around the world.

Sweet Bites’ Legacy

Sweet Bites has not just created a product but has also created a lifestyle. The company provides people with a product that will keep consumers happy and healthy. The product also teaches people about good oral hygiene habits and their effect on overall well-being. With several major global issues, it is often difficult to recognize seemingly minor issues that can spiral out of control when left unaddressed. Nevertheless, Sweet Bites creates a way to help those in need, which is truly the definition of giving back.

– Sara Jordan Ruttert
Photo: Flickr

Oral Health Literacy

Belarus, since 1991 an independent state in northeast Europe, remains somewhat isolated from the European mainstream as one of several successor states to the Soviet Union. Though the country hosts 4.08 physicians per 1,000 people, a figure comparable to many developed nations, there remain areas of the healthcare system that require improvement, and one such area is the dental health sector. For a dental health sector to treat the maximum number of citizens effectively, the population must attain a minimally competent level of oral health literacy. Several oral health literacy studies have diagnosed the quality of dental hygiene knowledge and provide strategies for improving oral literacy in the general population. Though data has been sparse since these studies, they suggest a continuing improvement in dental health and therefore in oral health literacy within the populace.

Oral Health Literacy in Post-Soviet Belarus

In 1996, several years after the dissolution of the USSR, oral health survey data established that tooth decay and periodontal disease affected approximately 85 percent of children and 100 percent of adults. Since then, these findings incentivized research into the development of successful and economical disease prevention strategies. Chief among these is ensuring oral health literacy.

A 2004 epidemiological study sought to uncover the link between urban or rural status and level of education on oral health literacy. The scope of the study encompassed randomly selected subjects from all six regions of Belarus, entailing administration of dental health examinations on six and 12 year-old children, questionnaires directed to mothers and primary school teachers and subsequent processing and interpretation of the data collected.

Of the children surveyed, 93 percent of tested six year-olds and 85 percent of tested 1- year-olds showed signs of tooth decay, with both 12- and six-year-old urban students less likely to have experienced tooth decay than their rural counterparts, although the contrast was more dramatic for 12-year-old test subjects. The questionnaires directed to mothers established that urban mothers were more likely than rural mothers to exhibit oral health literacy, and this knowledge disparity was likewise reflected in better oral hygiene habits in urban families. However, primary school teacher respondents provided generally accurate answers to the questionnaire, with no major knowledge disparity on based on the urban-rural divide.

This study concludes that a strong correlation existed between the knowledge and habits of parents and the dental health of their children. Both six- and 12-year-olds exhibited rates of tooth decay surpassing the 2000 goal set by World Health Organization for Europe, attributable to a myriad of factors encompassing diet, lifestyle change, inadequate parental involvement and mere lack of knowledge. Though primary school institutions should continue to play a pivotal role in dental hygiene education, parents must increase and improve their own role, facilitated through strategies promoting better access to updated dental health information.

Progress in Pediatric Oral Health Literacy since 2009

In order to determine whether progress has been made in oral literacy since these studies, one must consider the most recently released dental health statistics. Perhaps the most striking available data is that of pediatric dental patients’ DMFT index measurements. Dental epidemiologists record the degree to which a patient’s teeth suffer decay, are missing or filled, using a measurement called the DMFT index, which assigns values from zero to 28 or 32. On this scale, a lower score indicates less tooth damage.

In 2009, the Belarusian government determined that the mean DMFT of the country’s 12 year-olds rested at 2.1, while another study the same year found that 30.6 percent of children of the same age rested at zero in the DMFT index. Though the results of this DMFT study are now a decade old, they constitute a significant improvement over the prior decade, in which (as of 1998) only ten percent of 12 year-olds were cavity-free with a mean DMFT of 3.8.

NGO Involvement and a Trajectory for Improvement

Global Dental Ambassadors, an NGO comprised of dental health professionals committed to the exchange of data and improvement of oral health literacy, annually holds academic exchanges throughout the world. From 19 September to 21 September 2019, this organization held an international academic exchange summit at Belarusian State Medical University involving professionals from the United States and Belarus, with 523 second and third year students of the Belarusian State Medical University witnessing the proceedings. Conventions of this sort hold great promise for ensuring that the dental sector in Belarus remains fully literate on the latest developments within the profession.

Established in 2006 by Chernobyl Children International co-founder Mary Sugrue and dentist Marcas Mac Domhnaill, the Chernobyl Children International Dental Programme focuses primarily on improving the hygiene standard and general oral literacy of Belarusian pediatric dentistry. As Mary Sugrue attests, pediatric tooth extraction procedures did not involve the use of anaesthetic when the organization began working in Belarus. Since then, the organization has done much to decrease the infection rate through educating dentists and patients alike, including children.

Substantial progress has been made in the cause of Belarusian oral health literacy over the past several decades. The most recent data and international NGO involvement gives reason for optimism and incentivizes further investment in improving oral health literacy in Belarus.

– Philip Daniel Glass
Photo: Flickr